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813-78U-0020 �iry or cepnyrnms rire rax-aia-iau-uu�i <br /> Permit Application <br /> Date Received �� S� 1� Phone Contact for Permit &� � <br /> p. _. .._.. . _.. . a � z _ .. . -_ , . . _b. . . . <br /> Owner's Name /�t /T % E���MiwF-s Owner's Phone Number �( �3 ?!� G2G <br /> Owner's Address � 2 � � � !� �"✓� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titlehoider Address <br /> R . .. _ .�,: � ��-�z,�. �+ �;���-a°~_..o- �. ��� , . �-a�+�� <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> � ,., _ _ ,�,� •.ar,rt.r�x-w —.�� a�a�!:�..�- � x�* , <br /> - - - - - �'"G'#s�' - - - - - `- - . . . � r <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL / <br /> �y emi �n er �! �i( l /ti / <br /> 'T 7 V�t� <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm ❑ ❑ � � � Sparklers <br /> Hood Cleaning ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ► � r ,>���,�.��:,.,��>. �� #;� � � . _ .�.-: . ...� �-�., . . . . �����:� .�.., <br /> Contractor � � Company F�N F CS <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address / 0 h/ . �r (r-l'� �1 �/1� 1 d / o�fJ License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> t <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanicat work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date Parcel #- obtained from Property Tax Notice (http:/lappraiser.pascogov.com) <br />